TY - JOUR
T1 - Feasibility and preliminary efficacy for morning bright light therapy to improve sleep and plasma biomarkers in US Veterans with TBI. A prospective, open-label, single-arm trial
AU - Elliott, Jonathan E.
AU - McBride, Alisha A.
AU - Balba, Nadir M.
AU - Thomas, Stanley V.
AU - Pattinson, Cassandra L.
AU - Morasco, Benjamin J.
AU - Wilkerson, Andrea
AU - Gill, Jessica M.
AU - Lim, Miranda M.
N1 - Funding Information:
This material is the result of work supported with resources and the use of facilities at the VA Portland Health Care System, VA Career Development Award #1K2 BX002712, Oregon Institute for Occupational Health Sciences Pilot Project Award, NIH EXITO Institutional Core, #UL1GM118964, and the Portland VA Research Foundation to M.M.L.; VA Career Development Award #1K2 RX002947 to J.E.E; NIH T32 AT002688 to J.E.E and N.M.B.; NIH TL1 TR002371 to N.M.B.; Support for this work included funding from Department of Defense in the Center for Neuroscience and Regenerative Medicine #309698-7.01-65310 to M.M.L. and J.M.G. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Interpretations and conclusions are those of the authors and do not represent the views of the U.S. Department of Veterans Affairs, the National Institute of Health, or the United States Government.
Publisher Copyright:
Copyright: This is an open access article, free of all copyright, and may be freely reproduced, distributed, transmitted, modified, built upon, or otherwise used by anyone for any lawful purpose. The work is made available under the Creative Commons CC0 public domain dedication.
PY - 2022/4
Y1 - 2022/4
N2 - Mild traumatic brain injury (TBI) is associated with persistent sleep-wake dysfunction, including insomnia and circadian rhythm disruption, which can exacerbate functional outcomes including mood, pain, and quality of life. Present therapies to treat sleep-wake disturbances in those with TBI (e.g., cognitive behavioral therapy for insomnia) are limited by marginal efficacy, poor patient acceptability, and/or high patient/provider burden. Thus, this study aimed to assess the feasibility and preliminary efficacy of morning bright light therapy, to improve sleep in Veterans with TBI (NCT03578003). Thirty-three Veterans with history of TBI were prospectively enrolled in a single-arm, open-label intervention using a lightbox (~10,000 lux at the eye) for 60-minutes every morning for 4-weeks. Pre- and post-intervention outcomes included questionnaires related to sleep, mood, TBI, post-traumatic stress disorder (PTSD), and pain; wrist actigraphy as a proxy for objective sleep; and blood-based biomarkers related to TBI/sleep. The protocol was rated favorably by ~75% of participants, with adherence to the lightbox and actigraphy being ~87% and 97%, respectively. Post-intervention improvements were observed in self-reported symptoms related to insomnia, mood, and pain; actigraphy-derived measures of sleep; and blood-based biomarkers related to peripheral inflammatory balance. The severity of comorbid PTSD was a significant positive predictor of response to treatment. Morning bright light therapy is a feasible and acceptable intervention that shows preliminary efficacy to treat disrupted sleep in Veterans with TBI. A full-scale randomized, placebo-controlled study with longitudinal follow-up is warranted to assess the efficacy of morning bright light therapy to improve sleep, biomarkers, and other TBI related symptoms.
AB - Mild traumatic brain injury (TBI) is associated with persistent sleep-wake dysfunction, including insomnia and circadian rhythm disruption, which can exacerbate functional outcomes including mood, pain, and quality of life. Present therapies to treat sleep-wake disturbances in those with TBI (e.g., cognitive behavioral therapy for insomnia) are limited by marginal efficacy, poor patient acceptability, and/or high patient/provider burden. Thus, this study aimed to assess the feasibility and preliminary efficacy of morning bright light therapy, to improve sleep in Veterans with TBI (NCT03578003). Thirty-three Veterans with history of TBI were prospectively enrolled in a single-arm, open-label intervention using a lightbox (~10,000 lux at the eye) for 60-minutes every morning for 4-weeks. Pre- and post-intervention outcomes included questionnaires related to sleep, mood, TBI, post-traumatic stress disorder (PTSD), and pain; wrist actigraphy as a proxy for objective sleep; and blood-based biomarkers related to TBI/sleep. The protocol was rated favorably by ~75% of participants, with adherence to the lightbox and actigraphy being ~87% and 97%, respectively. Post-intervention improvements were observed in self-reported symptoms related to insomnia, mood, and pain; actigraphy-derived measures of sleep; and blood-based biomarkers related to peripheral inflammatory balance. The severity of comorbid PTSD was a significant positive predictor of response to treatment. Morning bright light therapy is a feasible and acceptable intervention that shows preliminary efficacy to treat disrupted sleep in Veterans with TBI. A full-scale randomized, placebo-controlled study with longitudinal follow-up is warranted to assess the efficacy of morning bright light therapy to improve sleep, biomarkers, and other TBI related symptoms.
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U2 - 10.1371/journal.pone.0262955
DO - 10.1371/journal.pone.0262955
M3 - Article
C2 - 35421086
AN - SCOPUS:85128335350
SN - 1932-6203
VL - 17
JO - PLoS One
JF - PLoS One
IS - 4 April
M1 - e0262955
ER -